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The metabolic response to acute coronary syndrome focusing on tissue factor, metalloproteinases and soluble CD40 ligand
Bis, Josef ; Vojáček, Jan (advisor) ; Mates, Martin (referee) ; Vítovec, Jiří (referee)
The metabolic response to acute coronary syndrome focusing on tissue factor,, metalloproteinases and soluble CD40 ligand Introduction: The cause of acute coronary syndrome is unstable plaque and its rupture. Pathogenesis is complex and requires various mechanisms and depends both on the composition of plaque and thrombotic activity of blood. Objectives: The main goal of this work was to assess local levels of plasma tissue factor (TF), tissue factor inhibitor (TFPI), tissue metalloproteinases (MMP-2, 3 and 9) and inhibitor of metalloproteinases-2 (TIMP-2), a highly selective C-reactive protein (CRP) and soluble CD40 ligand (sCD40L) in patients with acute coronary syndrome and with stable angina pectoris in the systemic circulation, the coronary sinus and to determine the time course of blood levels in patients with acute coronary syndrome. Methods and results: Study population include patients with coronary artery disease (CAD). In 24 patients with stable CAD (SCAD) at time of diagnostic coronary angiography, we withdrew samples from the coronary sinus (CS), femoral vein (VF) and left coronary artery (LMCA). In 29 patients with acute coronary syndrome (ACS) we took samples of venous blood also 24 hours and 7 days from the start. The samples were fixed levels of TF, TFPI, MMP-2, 3 and 9, TIMP-2, CRP, and...
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Contrast-induced acute kidney injury in high risk patients undergoing invasive cardiac procedures
Matějka, Jan ; Vojáček, Jan (advisor) ; Gregor, Pavel (referee) ; Červinka, Pavel (referee)
Contrast-induced acute kidney injury in high risk patients undergoing invasive cardiac procedures Introduction: Acute renal function impairment associated with radiologic procedures, known as contrast-induced acute kidney injury (CI-AKI), is strongly associated with a higher rate of morbidity, in-hospital mortality and diminished long-term survival. CI-AKI prevention focuses mainly on adequate periprocedural hydratation and use of a low amount of contrast media. Previous trials concerning use of adenosine antagonist theophylline revealed contradictory results. Goals: Our interventional trial sought to evaluate the effect of theophylline in CI-AKI prevention in well hydrated elderly patients with chronic kidney disease. Our cross-sectional study focused on CI-AKI in patients undergoing primary PCI for ST segment elevation myocardial infarction (STEMI). Methods: Interventional trial: randomized, double-blind, placebo-controlled trial was performed. 56 patients with estimated glomerular filtration rate bellow 60 60 ml/min/1.73m2 referred for cardiac coronary angiography and/or angioplasty were enrolled. 31 of them were randomly assigned to 200 mg theophylline IV before procedure, and 25 to placebo. Iso- osmolar contrast Iodixanol was used. Trial protocol included mandatory parenteral hydration. The...
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Radial approach to coronary catheterizations and interventions
Bernat, Ivo ; Rokyta, Richard (advisor) ; Vojáček, Jan (referee) ; Ošťádal, Petr (referee)
Radial approach in coronary catheterizations and interventions has been only an alternative of the femoral approach. But due to some important advantages radial approach has a chance to become the first choice in majority of catheterized patients. The most important advantage is the reduction of vascular access site bleeding complications. Additonal benefits are patient satisfaction, cost reduction, shorter hospital stay and possibility of the same-day discharge catheterizations and interventions. The aim of our work was to try to answer three open questions: 1. is it possible to catheterize majority of our patients from the left radial artery when 90% of them are right-handed ? 2. what is the optimal care for the radial artery after the procedure in prevention and treatment of radial artery occlusion? 3. is it effective to implement radial approach in primary PCI as a first approach for STEMI patients? The first part relates the left radial approach. After construction of our special variable support for the left arm and forearm we succesfully used this approach in our studies in almost 90% of patients. The second part of this work contains our randomized trial comparing two different doses of unfractionated heparin in prevention of radial artery occlusion after diagnostic cardiac catheterizations....
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Myocardial regeneration after intracoronary injection of autologous bone marrow-derived mononuclear cells in patients with large anterior acute myocardial infarction and late reperfusion
Skalická, Hana ; Horák, Jan (advisor) ; Vojáček, Jan (referee) ; Málek, Ivan (referee)
Myocardial regeneration after intracoronary injection of autologous bone marrow-derived mononuclear cells in patients with large anterior acute myocardial infarction and late reperfusion Objective and background: Despite the use of reperfusion therapies, outcomes in patients with large ST elevation myocardial infarction (STEMI), late reperfusion and left ventricular (LV) dysfunction is poor. We investigated longterm safety and efficacy of intracoronary injections of autologous bone marrow-derived mononuclear cells (BMNCs). Methods: 27 patients with anterior STEMI (age 59 ± 12 yrs, mean baseline LV ejection fraction (LVEF) 39±5%), who underwent percutaneous coronary intervention 4-24 hours after the onset of symptoms, were randomly assigned either to intracoronary BMNCs injection (n = 17, BMNCs group, out of which 14 underwent longterm follow-up), or to standard therapy (n = 10, Control group). The LVEF, the LV end-diastolic and end-systolic volumes (LVEDV, LVESV) and diastolic function (transmitral flow, pulmonary vein flow) were assessed by echocardiography at discharge, month 4 and 24. Myocardial perfusion was assessed using SPECT at baseline and month 4. Results: At 24-month, there was no difference in rates of serious clinical events (36% vs. 50%, p=0,54). At Month 4 LVEF improved to similar extent in...
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Diagnosing vascular prosthesis infection by means of the FDG-PET/CT
Špaček, Miroslav ; Bělohlávek, Otakar (advisor) ; Vojáček, Jan (referee) ; Gregor, Zdeněk (referee)
Introduction: Vascular prosthesis infection (VPI) is a life-threatening complication in 0.5- 5% of cases. Early and reliable diagnosis is a necessity for adequate treatment. Computed tomography (CT) is the gold standard diagnostic method used world-wide with excellent results, but in cases of advanced graft infection. Low grade infections in non-acute patients are a diagnostic challenge requiring a new method with good diagnostic accuracy. The aim of this work is to define the accuracy of 18 F-FDG PET/CT in these settings and to identify essential parameters of its evaluation. Material and Methods: Seventy-six consecutive patients with total of 96 vascular prosthetic grafts in which infection was suspected underwent PET/CT examination prospectively. PET/CT scans were analysed in terms of presence and intensity of focal and diffuse FDG uptake, presence of anastomotic pseudoaneurysm, irregular boundary of infiltration, combination of these, and uptake ratio between graft and blood background. Also, other parameters like white blood cell count, C-reactive protein, and microbiological cultures were tested. The final diagnosis (gold standard) was based on operative/histopathological finding or >6 months clinical follow up. Results: In our series the prevalence of VPI was 57.3 % (55/96 prostheses). Among various...
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Effect of perinatal hypoxia on cardiac tolerance to acute ischaemia in adult male and female rats.
Netuka, Ivan ; Pirk, Jan (advisor) ; Tošovský, Jan (referee) ; Vojáček, Jan (referee)
Background: The number of adult patients with history of hypoxaemic insult in childhood has increased significantly. Cardiac interventions performed on these individuals in adulthood have become frequent. The evidence of their possibly specific response to ischaemia while undergoing these procedures is scarce and not sufficiently conclusive. Aim: The aims can be summarized as follows: 1. to develop a method of appropriate measurement and assessement of infarct size induced by regional ischaemia on isolated perfused rat heart; 2. to examine the effect of different types of perinatal hypoxia to the tolerance of the adult myocardium to acute ischaemia/reperfusion injury with regard to sex. (...) Conclusions: The results of the present study support the hypothesis that perinatal hypoxia is a primary programming stimulus in the heart that may lead to sex-dependent changes in cardiac tolerance to acute ischaemia in later adult life. This would have important implications for patients who have experienced prolonged hypoxaemia in early life.
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Implantation of cryopreserved mitral allograft into tricuspidal position in an experiment with sheep: Technical aspects of implantation and immediate results evaluated with the aid of epicardial echocardiography
Vojáček, Jan ; Špatenka, Jaroslav (advisor) ; Dominik, Jan (referee) ; Třeška, Vladislav (referee) ; Černý, Štěpán (referee)
Aortic, mitral and pulmonary valve replacement is routinely performed with reasonable clinical results. But the optimal substitute for the tricuspid valve remains controversial. Contemporary prostheses either mechanical or bioprosthetic are associated with a high risk of thrombosis and/or structural failure. Mitral allografts could have advantages over existing prostheses, especially in patients with infectious endocarditis. We describe our first experience with cryopreserved mitral allograft processing and implantation into the tricuspid position in a sheep experimental model. Material and Methods: We subjected 20 sheep (age 1 year, weight 23 - 36 kilograms) to general anesthesia and a left thoracotomy. An epicardial echocardiographic study was performed and the mitral valve was harvested. Donor animals were put to death by intravenous anesthetics injection. Allografts were immersed into cultivation medium E 199 with an antibiotic cocktail. After 24 hours storage at the temperature of 37.0oC the valves were kept at + 5 to + 7 oC over a period of 3-5 days. Then they were transferred into the cryoprotective solution (E 199 with 10% dimethylsulfoxide) and sealed into plastic bags using a double-layer technique. Finally, they were programmed cooled and stored in the liquid stage of liquid nitrogen (- 196 oC)...
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